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Erschienen in: European Spine Journal 1/2015

01.01.2015 | Original Article

Computed tomographic morphometric analysis of cervical pedicles in a multi-ethnic Asian population and relevance to subaxial cervical pedicle screw fixation

verfasst von: Thangaraj Munusamy, Ady Thien, Mark Gerad Anthony, Ramesh Bakthavachalam, Shree Kumar Dinesh

Erschienen in: European Spine Journal | Ausgabe 1/2015

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Abstract

Purpose

Pedicle screw instrumentation provides optimal stabilization of the cervical spine complex, but is associated with risk of neurovascular injury. Sex and ethnic disparities may compromise safe and accurate screw placement. Therefore, a comprehensive analysis of pedicle dimensions derived from computed tomography scans is pertinent for our multi-ethnic population.

Methods

Cervical spine CT of 50 patients without significant cervical spine pathology was selected. Pedicle width (PW), pedicle height (PH) and pedicle transverse angle (PTA) from C3 to C7 were measured and subsequently analyzed for sex and ethnic differences.

Results

The smallest mean PW was at C4 in males and C3 in females. Mean PW for males was significantly greater than females at all levels (P < 0.05). 8 % of our population had at least one PW < 4.00 mm. At C5, C6 and C7 there is zero percent incidence of PW < 4.00 mm. The mean PH in males was significantly greater than females at all levels (P < 0.05), but no statistically significant sex differences in mean PTA values were found. There were significant ethnic differences in mean PW of males at C4, C5 and C7 (P < 0.05) and mean PH of females at C3, C4 and C7 (P < 0.05).

Conclusions

Transpedicular screw fixation is generally feasible in our population except for 8 % with at least one PW < 4.00 mm. However, in view of significant sex and ethnic morphometric variability, pre-operative CT evaluation together with image-guided screw placement is highly advised to ensure safety and accuracy.
Literatur
1.
Zurück zum Zitat Abumi K, Itoh H, Taneichi H, Kaneda K (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 7:19–28PubMedCrossRef Abumi K, Itoh H, Taneichi H, Kaneda K (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 7:19–28PubMedCrossRef
2.
Zurück zum Zitat Abumi K, Kaneda K, Shono Y, Fujiya M (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90:19–26PubMed Abumi K, Kaneda K, Shono Y, Fujiya M (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90:19–26PubMed
3.
Zurück zum Zitat Abumi K, Shono Y, Ito M et al (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976) 25:962–969CrossRef Abumi K, Shono Y, Ito M et al (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976) 25:962–969CrossRef
4.
Zurück zum Zitat Bozbuga M, Ozturk A, Ari Z et al (2004) Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation. Spine (Phila Pa 1976) 29:1876–1880CrossRef Bozbuga M, Ozturk A, Ari Z et al (2004) Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation. Spine (Phila Pa 1976) 29:1876–1880CrossRef
5.
Zurück zum Zitat Chazono M, Soshi S, Inoue T et al (2006) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography reconstruction measurements. J Neurosurg Spine 4:472–477PubMedCrossRef Chazono M, Soshi S, Inoue T et al (2006) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography reconstruction measurements. J Neurosurg Spine 4:472–477PubMedCrossRef
6.
Zurück zum Zitat Chazono M, Tanaka T, Kumagae Y et al (2012) Ethnic differences in pedicle and bony spinal canal dimensions calculated from computed tomography of the cervical spine: a review of the English-language literature. Eur Spine J 21:1451–1458PubMedCentralPubMedCrossRef Chazono M, Tanaka T, Kumagae Y et al (2012) Ethnic differences in pedicle and bony spinal canal dimensions calculated from computed tomography of the cervical spine: a review of the English-language literature. Eur Spine J 21:1451–1458PubMedCentralPubMedCrossRef
7.
Zurück zum Zitat Coe JD, Warden KE, Sutterlin CE, McAfee PC (1989) Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976) 14:1122–1131CrossRef Coe JD, Warden KE, Sutterlin CE, McAfee PC (1989) Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976) 14:1122–1131CrossRef
8.
Zurück zum Zitat Dinesh SK, Tiruchelvarayan R, Ng I (2012) A prospective study on the use of intraoperative computed tomography (iCT) for image-guided placement of thoracic pedicle screws. Br J Neurosurg 26:838–844PubMedCrossRef Dinesh SK, Tiruchelvarayan R, Ng I (2012) A prospective study on the use of intraoperative computed tomography (iCT) for image-guided placement of thoracic pedicle screws. Br J Neurosurg 26:838–844PubMedCrossRef
9.
Zurück zum Zitat Karaikovic EE, Daubs MD, Madsen RW, Gaines RW (1997) Morphologic characteristics of human cervical pedicles. Spine (Phila Pa 1976) 22:493–500CrossRef Karaikovic EE, Daubs MD, Madsen RW, Gaines RW (1997) Morphologic characteristics of human cervical pedicles. Spine (Phila Pa 1976) 22:493–500CrossRef
10.
Zurück zum Zitat Karaikovic EE, Yingsakmongkol W, Gaines RW (2001) Accuracy of cervical pedicle screw placement using the funnel technique. Spine (Phila Pa 1976) 26:2456–2462CrossRef Karaikovic EE, Yingsakmongkol W, Gaines RW (2001) Accuracy of cervical pedicle screw placement using the funnel technique. Spine (Phila Pa 1976) 26:2456–2462CrossRef
11.
Zurück zum Zitat Koller H, Acosta F, Tauber M et al (2008) Cervical anterior transpedicular screw fixation (ATPS)–Part II. Accuracy of manual insertion and pull-out strength of ATPS. Eur Spine J 17:539–555PubMedCentralPubMedCrossRef Koller H, Acosta F, Tauber M et al (2008) Cervical anterior transpedicular screw fixation (ATPS)–Part II. Accuracy of manual insertion and pull-out strength of ATPS. Eur Spine J 17:539–555PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Koller H, Hempfing A, Acosta F et al (2008) Cervical anterior transpedicular screw fixation. Part I: study on morphological feasibility, indications, and technical prerequisites. Eur Spine J 17:523–538PubMedCentralPubMedCrossRef Koller H, Hempfing A, Acosta F et al (2008) Cervical anterior transpedicular screw fixation. Part I: study on morphological feasibility, indications, and technical prerequisites. Eur Spine J 17:523–538PubMedCentralPubMedCrossRef
13.
Zurück zum Zitat Ling JM, Dinesh SK, Pang BC et al (2014) Routine spinal navigation for thoraco-lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy. J Clin Neurosci 21:493–498PubMedCrossRef Ling JM, Dinesh SK, Pang BC et al (2014) Routine spinal navigation for thoraco-lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy. J Clin Neurosci 21:493–498PubMedCrossRef
14.
Zurück zum Zitat Ludwig SC, Kowalski JM, Edwards CC, Heller JG (2000) Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine (Phila Pa 1976) 25:2675–2681CrossRef Ludwig SC, Kowalski JM, Edwards CC, Heller JG (2000) Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine (Phila Pa 1976) 25:2675–2681CrossRef
15.
Zurück zum Zitat Mason A, Paulsen R, Babuska JM et al (2014) The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine 20:196–203PubMedCrossRef Mason A, Paulsen R, Babuska JM et al (2014) The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine 20:196–203PubMedCrossRef
16.
Zurück zum Zitat Onibokun A, Khoo LT, Bistazzoni S et al (2009) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography measurements in 122 consecutive clinical cases. Spine J 9:729–734PubMedCrossRef Onibokun A, Khoo LT, Bistazzoni S et al (2009) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography measurements in 122 consecutive clinical cases. Spine J 9:729–734PubMedCrossRef
17.
Zurück zum Zitat Panjabi MM, Duranceau J, Goel V et al (1991) Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine (Phila Pa 1976) 16:861–869CrossRef Panjabi MM, Duranceau J, Goel V et al (1991) Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine (Phila Pa 1976) 16:861–869CrossRef
18.
Zurück zum Zitat Rao RD, Marawar SV, Stemper BD et al (2008) Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am 90:1914–1921PubMedCrossRef Rao RD, Marawar SV, Stemper BD et al (2008) Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am 90:1914–1921PubMedCrossRef
19.
Zurück zum Zitat Rezcallah AT, Xu R, Ebraheim NA, Jackson T (2001) Axial computed tomography of the pedicle in the lower cervical spine. Am J Orthop (Belle Mead NJ) 30:59–61 Rezcallah AT, Xu R, Ebraheim NA, Jackson T (2001) Axial computed tomography of the pedicle in the lower cervical spine. Am J Orthop (Belle Mead NJ) 30:59–61
20.
Zurück zum Zitat Ruofu Z, Huilin Y, Xiaoyun H et al (2008) CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement. Surg Radiol Anat 30:389–396PubMedCrossRef Ruofu Z, Huilin Y, Xiaoyun H et al (2008) CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement. Surg Radiol Anat 30:389–396PubMedCrossRef
21.
Zurück zum Zitat Sakamoto T, Neo M, Nakamura T (2004) Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine (Phila Pa 1976) 29:2510–2514 (Discussion 2515)CrossRef Sakamoto T, Neo M, Nakamura T (2004) Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine (Phila Pa 1976) 29:2510–2514 (Discussion 2515)CrossRef
22.
Zurück zum Zitat Sieradzki JP, Karaikovic EE, Lautenschlager EP, Lazarus ML (2008) Preoperative imaging of cervical pedicles: comparison of accuracy of oblique radiographs versus axial CT scans. Eur Spine J 17:1230–1236PubMedCentralPubMedCrossRef Sieradzki JP, Karaikovic EE, Lautenschlager EP, Lazarus ML (2008) Preoperative imaging of cervical pedicles: comparison of accuracy of oblique radiographs versus axial CT scans. Eur Spine J 17:1230–1236PubMedCentralPubMedCrossRef
23.
Zurück zum Zitat Tan SH, Teo EC, Chua HC (2004) Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J 13:137–146PubMedCentralPubMedCrossRef Tan SH, Teo EC, Chua HC (2004) Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J 13:137–146PubMedCentralPubMedCrossRef
24.
Zurück zum Zitat Yusof MI, Ming LK, Abdullah MS (2007) Computed tomographic measurement of cervical pedicles for transpedicular fixation in a Malay population. J Orthop Surg (Hong Kong) 15:187–190 Yusof MI, Ming LK, Abdullah MS (2007) Computed tomographic measurement of cervical pedicles for transpedicular fixation in a Malay population. J Orthop Surg (Hong Kong) 15:187–190
25.
Zurück zum Zitat Yusof MI, Ming LK, Abdullah MS, Yusof AH (2006) Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine (Phila Pa 1976) 31:E221–4 Yusof MI, Ming LK, Abdullah MS, Yusof AH (2006) Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine (Phila Pa 1976) 31:E221–4
Metadaten
Titel
Computed tomographic morphometric analysis of cervical pedicles in a multi-ethnic Asian population and relevance to subaxial cervical pedicle screw fixation
verfasst von
Thangaraj Munusamy
Ady Thien
Mark Gerad Anthony
Ramesh Bakthavachalam
Shree Kumar Dinesh
Publikationsdatum
01.01.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 1/2015
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3526-1

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